WHO STEPS for surveillance of major NCD

risk factors

Peter Sousa Hoejskov

Technical Officer – Food Safety & NCD

Pacific Regional Workshop on Promotion of Fruit and

Vegetables for Health – PROFAV, Nadi, Fiji, 20-23 October 2014

The NCD pathway

NCDs

ed

BPOverweight/obesityRaised

blood

glucoseRaised

lipids

useUnhealthy

dietPhysical

inactivityHar

mful

use

of

alcohol

tionUrbanizationPopulation

ageingSocial

deter

minants

of

health

Behavioural risk factors

Metabolic risk factors

Risk Factors Common to Major NCD Conditions

Risk Factor Condition

Cardiovascular diseases

Diabetes Cancer Respiratory Conditions

Tobacco use √ √ √ √

Harmful use of alcohol √ √ √

Low fruit & vegetable √ √ √

Physical Inactivity √ √ √ √

Obesity √ √ √

Raised blood pressure √ √

Raised blood glucose √ √ √

Abnormal blood lipids √ √ √

Why measure these risk factors?

• Greatest impact on NCD morbidity and mortality

• Modification is possible through effective prevention

• Measurement of risk factors proven to be valid

• Measurements can be obtained using appropriate ethical standards

• Information can be used to set up NCD policy interventions and programmes

What is STEPS?

• System for surveillance of these NCD risk factors

• Designed for implementation in low- and middle income countries

• Most countries in the Pacific have conducted at least one STEPS survey

Objectives of STEPS

• Gather information on NCD risk factors to help plan programmes and interventions

• Collect standardized risk factor data to enable comparisons, but allow flexibility

• Provide an entry point for low- and middle income countries to get started on chronic disease surveillance

• Build capacity in countries

• Integrated approach at relative low cost

STEPS methods – The risk factors

• Behavioural Risk Factors

– Tobacco use

– Harmful alcohol consumption

– Unhealthy diet (low fruit and vegetable consumption)

– Physical inactivity

• Biological Risk Factors

– Overweight and obesity

– Raised blood pressure

– Raised blood glucose

– Abnormal blood lipids

STEPS methods – The framework

Different levels of risk factor assessment:

• STEP 1 – questionnaire

• STEP 2 – physical measurements

• STEP 3 – blood and urine samples

Three modules:

• Core

• Expanded

• Optional

1

Step 1: QuestionnaireStep 1: Questionnaire

� Core:– Socio-demographic info

– Tobacco use, quit attempts, past use

– Alcohol consumption

– Fruit & vegetable consumption

– Salt intake

– Physical inactivity

– History & treatment of raised BP, diabetes, raised cholesterol, CVD

– Lifestyle advice

– Cervical cancer screening

– Salt intake

� Expanded:– Cessation, smokeless tobacco use, ETS

– Alcohol use disorders

– Oil consumption, meals outside a home

– Sedentary behaviour

Step 1: Questionnaire

Fruits and vegetables intake

1

2

� Core:– Blood pressure

– Height

– Weight

– Waist circumference

� Expanded:– Hip circumference

– Heart rate

Step 2: Physical measurements

3

2

1

� Core:– Urinary sodium and

creatinine

– Fasting blood sugar

– Fasting total cholesterol

� Expanded:– Triglycerides

– HDL cholesterol

Step 3: Biochemical measurements

� Mental health / suicide

� Oral health

� Sexual health

� Tobacco policy

� Violence and injury

Optional modules

� Standard methods and tools, but also

� Flexible for adaptation to cultural and local needs

� Simple

� Hierarchical

� Can add on to existing systems

Why a STEPwise framework to surveillance?

STEPS methods –recommendations

• Targets a scientific sample of adults aged 18 – 69

• Household surveys conducted using trained interviewers for STEP 1 (questionnaire) and STEP 2 (physical measures)

• Clinic based for STEP 3 (biochemical measures)

• Countries should at least do core questions STEP 1 and 2

• Repeat surveys every 5 years

Recognize need for data on NCD risk

factors

Begin STEPS

Planning

STEPS

Implementation

Workshop

Conduct STEPS

Report Results

ImplementInterventions

STEPS Data

Analysis &

Reporting

Workshop

STEPS Data

Collection

Workshop

STEPS methods – the Surveillance loop

Prevalence of diabetes

Prevalence of obesity

Raised blood pressure

STEPS website